Exam 1 Flashcards
a clinical syndrome in which there is a sustained increase in the synthesis and release of thyroid hormones by the thryoid gland
hyperthyroidism
a condition associated with overproduction or oversecretionof ADH
syndrome of inappropriate antidiuretic hormone
enlargement of the thyroid gland that may be associated with hyperthyroidism, hypothyroidism, or normal thyroid function
goiter
the physiological cessation of menses associated with declining ovarian function
menopause
a physiical examination technique in which the examiner feels the texture, size, consistency, and location of certain body parts with the hands
palpation
an acute metabolic complication of diabetes occurring when fats are metabolized in the absence of insulin resulting in formation of acid by-products, such as ketones
diabetic ketones
a rare disorder that involves a decrease in one or more of the pituitary hormones and marked by excessive deposits of fat and persistence or acquisition of adolescent characteristics
hypopituitarism
formation of focal deposits of cholesterol and lipids known as atheromas or plaque, primarily within the intamil wall of arteries, that obstruct circulation
atherosclerosis
a metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility and pathologic fractures
osteoporosis
a condition caused by excessvie secretion of growth hormone characterized by an overgrowth of the bones and soft tissues
acromegaly
a rare condition characterized by a tumor of the adrenal medulla that produces excessive catecholamines causing persistent or intermittent hypertension
pheochromocytoma
a paroxsymal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function leading to a sudden, violent involuntary series of contractions of a group of muscles
seizure
a group of conditions associated with deficient production or secretion of antidiuretic hormone, or a decreased renal response to ADH caused by injury of the neuropophyseal system
diabetes insipidus
a physical examination technique in which the examiner taps the body with the fingertips or fist
percussion
a multisystem disease related to abnormal insulin production, impaired insulin utilization, or both
diabetes mellitus
A characteristic common to all hormones is that they
a. circulate in the blood bound to plasma proteins
b. influence cellular activity of specific target tissues
c. accelerate the metabolic processes of all body cells.
d. enter a cell to alter the cell’s metabolism or gene expression
B. influence cellular activity of specific target tissues
A patient is receiving radiation therapy for cancer of the kidney. The nurse monitors the patient for signs and symptoms of damage to the
a. pancreas
b. thyroid gland
c. adrenal glands
d. posterior pituitary gland
C. adrenal glands
A patient has a serum sodium level of 152 mEq/L. The normal hormonal response to this situation is
a. release of ADH
b. release of ACTH
c. secretion of aldosterone
d. secretion of corticotropin-releasing hormone
A. release of ADH
All cells in the body are believed to have intracellular receptors for
a. insulin
b. glucagon
c. growth hormone
d. thyroid hormone
D. thyroid hormone
When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about
a. energy level
b. intake of vitamin C
c. employment history
d. frequency of sexual intercourse
A. energy level
Endocrine disorders often go unrecognized in the older adult because
a. symptoms are often attributed to aging
b. older adults rarely have identifiable symptoms
c. endocrine disorders are relatively rare in the older adult
d. older adults usually have subclinical endocrine disorders that minimize symptoms
A. symptoms are often attributed to aging
An abnormal finding by the nurse during an endocrine assessment would be
a. blood pressure of 100/70 mm Hg.
b. excessive facial hair on a woman
c. soft, formed stool every other day
d. 3lb weight gain over last 6 months
e. hyperpigmented coloration in lower legs
B. excessive facial hair on a woman
E. hyperpigmented coloration in lower legs
A patient has a total serum calcium level of 3mg/dL (1.5mEq/L). If this finding reflects hypoparathyroidism, the nurse would expect further diagnositc testing to reveal
a. decreased serum PTH
b. increased serum ACTH
c. increased serum glucose
d. decreased serum cortisol levels
A. decreased serum PTH
nerve damage caused by the metabolic derangements associated with diabetes mellitus
diabetic neuropathy
an intermediate stage between normal glucose homeostasis and diabetes where the blood glucose level is 140 mg/dL (7.8mmol/L) to 199mg/dL (11 mmol/L) 2 hours after a meal
impaired glucose tolerance
any type of bladder dysfunction related to abnormal or absent bladder innervation caused by a lesion of the nervous system
neurogenic bladder
a common disorder characterized by sustained elevation of blood pressure
hypertension
the amount of blood filtered by the glomeruli in a given time
glomerular filtration rate
a separation of the retina from the retinal pigment epithelium in the back of the eye, allowing the vitreous humor to leak between the two layers
retinal detachment
a pruritic skin eruption characterized by transient wheal of varying shapes and sizes with well defined erythematous margins and pale centers; usually an allergic phenomenon
urticaria
a microvascular complication of diabetes mellitus associated with damage to the small blood vessels that supply the glomeruli of the kidney
diabetic nephropathy
impaired glucose tolerance; occurs when a 2 hour plasma glucose level is higher than normal but lower than that considered diagnostic for diabetes
prediabetes
an inflammation of the mucosa of the stomach and small intestine
gastroenteritis
wasting of muscle, characterized by decreased circumference and flabby appearance leading to decreased function and tone
atrophy
systemic inflammatory response to infection
sepsis
the process of microvascular damage of the retina; may develop slowly or rapidly
retinopathy
an acute and life threatening hypersensitivity reaction to a sensitizing substance, such as a drug, chemical, vaccine, food, or insect venom
anapyhlactic shock
the inability to empty the bladder despite micturition, or the accumulation of urine in the bladder because of an inablity to urinate
urinary retention
increased accumulation of fluid in the extracellular spaces of brain tissue that can lead to increased intracranial pressure
cerebral edema
a condition in which body tissues do not respond to the action of insulin
insulin resistance
a life threatening syndrome that can occur in the patient with diabetes who is able to produce enough insulin to prevent diabetic ketoacidosis but not enough to prevent severe hyperglycemia
hypersmolar hyperglycemic syndrome
redness or inflammation of the skin or mucous membranes that result from dilation and congestion of superficial capillaries
erythema
a group of disorders characterized by 1. intraocular pressure and the consequences of elevated pressure, 2. optic nerve atrophy, 3. peripheral visual field loss
glaucoma
a solution that has a lower concentration of solute than another solution, thus exerting less osmotic pressure on a semipermeable membrane
hypotonic
producing <400ml of urine in 24 hours
oliguria
technique in which substances move from the blood through a semipermeable membrane and into a dialysis solution
dialysis
a collection of risk factors that increase an individual’s chance of developing cardiovascular disease and diabetes mellitus
metabolic syndrome
term used to describe the rise in blood glucose levels after a person has consumed a carbohydrate containing food
glycemic index
progressive destruction of the pancrease with fibrotic replacement of pancreatic tissue
chronic pancreatitis
an intermediate stage between normal glucose homeostasis and diabetes
impaired fasting glucose
a disorder involving a thrombus in a deep vein; most commonly the iliac and femoral veins
deep vein thrombosis
a condition in which an excessive dose of insulin causes blood glucose levels to decline during sleep, triggering the release of counterregulatory hormones that increase the blood glucose
Somogyi effect
Polydipsia and polyuria related to diabetes mellitus are primarily due to:
a. the release of ketones from cells during fat metabolism
b. fluid shifts resulting from the osmosis effect of hyperglycemia
c. damage to the kidneys from exposure to high levels of glucose
d. changes in RBCs resultinf from attachment of excessive glucose to hemoglobin
B. fluid shifts resulting from the osmosis effect of hyperglycemia
Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia?
a. the patient must receive insulin therapy to prevent ketoacidosis
b. the patient has islet cell antibodies that have destroyed the pancreas’s ability to produce insulin
c. the patient has minimal or absent endogenous insulin secretion and requires daily insulin injections
d. the patient may have suficient endogenous insulin to prevent ketosis, but is at risk for hypersmolar hyperglycemic syndrome
D. the patient may have suficient endogenous insulin to prevent ketosis, but is at risk for hypersmolar hyperglycemic syndrome
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b, BP 126/80 mm Hg c. FBG 130 mg.dL (7.2mmol/L) d. LDL cholesterol 100mg/dL (2.6mmol/L)
A. A1C 9%
Which statement by the patient with type 2 diabetes is accurate?
a. I am supposed to have a meal or snack if I drink alcohol
b. I am not allowed to eat any sweets because of my diabetes
c. I do not need to watch what I eat because my diabetes is not the bad kind
d. The amount of fat in my diet is not important. Only carbohydrate raise my blood sugar
A. I am supposed to have a meal or snack if I drink alcohol
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital.
a. insulin administration
b. elimination of sugar from diet
c. need to reduce physical activity
d. use of a portable blood gluose monitor
e. hypoglycemia prevention, symptoms, and treatment
A D E
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability?
a. call the physician
b. administer insulin as ordered
c. check the patient’s blood glucose level
d. asses for other neurologic symptoms
C. check the patient’s blood glucose level
A diabetic patient has a serum glucose level 824mg/dL and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hypersmolar hyperglycemic syndrome based on the finding of
a. polyuria
b. severe, dehydration
c. rapid, deep respirations
d. decreased serum potassium
C. rapid, deep respirations
Which are appropriate therapies for patients with diabetes mellitus?
a. use of statins to treat dyslipidemia
b. use of diuretics to treat nephropathy
c. use of ACE inhibitors to treat nephropathy
d. use of serotonin agonists to decrease appetite
e. use of laser photocoagulation to treat retinopathy
A C E
the dilated, tortuous subcutaneous veins most frequently found in the saphenous system
varicose veins
the osmotic pressure of a colloid in solution
oncotic pressure
an abnormal intraperitoneal accumulation of a fluid containing large amounts of protein and electrolytes as a result of portal hypertension
ascites
a procedure in which fluid is withdrawn from a cavity of the body
paracentesis
a state of temporary but acute mental confusion
delirium
the amount of blood pumped by each ventricle in 1 minute
cardiac output
dialysis that uses an artificial membrane as the semipermeable membrane through which the patient’s blood circulates
hemodialysis
the force that fluid exerts within a compartment
hydrostatic pressure
an acute, rapidly progressing, and potentially fatal form of polyneuritis possibly caused by a cell-mediated immunologic reaction directed at the peripheral nerves
Guilain-Barre syndrome
low oxygen tension in the blood characterized by a variety of nonspecific clinical signs and symptoms
hypoxemia
a solution that increases the degree of osmotic pressure on a semipermeable membrane
hypertonic
a chronic inflammatory bowel disease that causes ulceration of the colon and rectum
ulcerative colitis
a condition in which malignant neoplastic plasma cells infiltrate the bone marrow and destroy bone
multiple myeloma
the formation of stones in the urinary tract
nephrolithiasis
clinical syndrome characterized by a rise in serum creatinine and/or a reduction in urine output
acute kidney injury
a surgical procedure done to remove fluid from the pleural space
thoracentesis
shortness of breath; difficulty breathing that may be caused by certain heart or lung conditions, strenous exercise, or anxiety
dyspnea
agents that when accidently infiltrated into the skin cause severe local tissue breakdown and necrosis
vessicants
an acute inflammation of the brain usually caused by a virus
encephalitis
a severe derangement of the heart rhythm characterized on ECG by irregular undulations of varying contour and amplitude
ventricular fibrillation
the inflammation of the peritoneum
peritonitis
an acute, life threatening situation in which the lung alveoli become filled with serous or serosanguineous fluid, caused most commonly heart failure
pulmonary edema
a rare condition of adult bones associated with vitamin D deficiency, resulting in decalcification and softening of bone
osteomalacia
a broad term given to a group of malignant diseases characterized by diffuse replacement of bone marrow with proliferating leukocyte precursors
leukemia
a collection of air gas in the pleural space causing the lung to collaps
pneumothorax
a maneuver that involves contraction of the chest muscles on a closed glottis with simultaneous contraction of the abdominal muscles
Valsalva maneuver
a condition that occurs when an ectopic focus or foci fire repetitively and the ventricle takes control as the pacemaker
ventricular tachycardia
the presence of kidney damage or decreased glomerular filtration rate for at least 3 months with functional or structural abnormalities, with or without decreased glomerular filtration rate
chronic kidney disease
the state in which the PaO2 has fallen sufficiently to cause signs and symptoms of inadequate oxygenation
hypoxia
provides a means by which solutes and fluids can be removed slowly and continuously in the hemodynamically unstable patient
continous renal replacement therapy
the most serious form of heat stress; results from failure of the central thermoregulatory mechanisms and is considered a medical emergency
heatstroke
difficulty swallowing
dysphagia
During the postoperative care of a 76 year old patient, the nurse monitors the patient’s intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because
a. older adults have an impaired thirst mechanism and need reminding to drink fluids
b. water accounts for a greater percentage of body weight in the older adult than in younger adults
c. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures.
d. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults
D. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults
During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is
a. osmosis
b. diffusion
c. active transport
d. faciltated diffusion
A. osmosis
An older woman was admitted to the medical unit with dehydration. Clinical indications of this problem are
a. weight loss
b. dry oral mucosa
c. full bounding pulse
d. engorged neck veins
e. facilitated diffusion
A B E
The nursing care for a patient with hyponatremia includes
a. fluid restriction
b. administration of hypotonic IV fluids
c. administration of a cation-exchange resin
d. increased water intake for patients on nasogastric suction
A fluid restriction
The nurse should be alert for which manifestations in a patient receiving a loop diuretic?
a. restlessness and agitation
b. parasthesis and irritability
c. weak, irregular pulse and poor muscle tone
d. increased blood pressure, and muscle spasms
C. weak irregular pulse and poor muscle tone
Which patient would be at greatest risk for the potential development of hypermagnesemia?
a. 83 year old man with lung cancer and hypertension
b. 65 year old woman with hypertension taking beta-adrenergic blockers
c. 42 year old woman with systemic lupus erythematosus and renal failure
d. 50 year old man with benign prostatic hyperplasia and a urinary tract infection
C. 42 year old woman with systemic lupus erythematosus and renal failure
It is especially important for the nurse to assess for which clinical manifestation (s) in a patient who has just undergone a total thyroidectomy
a. confusion
b. weight gain
c. depressed reflexes
d. circumoral numbness
e. postive Chvostek’s signs
A D E
The nurse anticipates that treatment of the patient with hyperphosphatemia secondary to renal failure will include
a. fluid restriction
b. calcium supplements
c. loop diuretic therapy
d. magnesium supplements
B. calcium supplements
The lungs act as an acid-base buffer by
a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.
b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load
c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load
d. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load
A. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load
A patient has the following arterial blood gas results pH 7.52; PaCO2 30 mm Hg; HCO3 24 mEq/L. The nurse determines that these results indicate:
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis
D. respiratory alkalosis
The typical fluid replacement for the patient with a fluid volume deficit is
a. dextran
b. 0.45% saline
c. lactated Ringer’s
d. 5% dextrose in 0.45% saline
C. lactated Ringer’s
The nurse is unable to flush a central venous access device and suspect occlusion. The best nursing intervention would be to
a. apply warm moist compresses to the insertion site
b. attempt to force 10ml of normal saline into the device
c. place the patient on the left side with head down position
d. instruct the patient to change positions, raise arm, and cough
D. instruct the patient to change positions, raise arm, and cough
major cation of plasma
Na+
major anion of plasma
Cl-
major cation of intracellular
K+
major anion of intracellular
PO4 3-
22-26mEq/L
normal serum Bicarbonate levels
96-106 mEq/L
normal serum Chloride levels
2.4-4.4 mg/dL
normal serum Phosphate levels
3.5-5.0 mEq/L
normal serum Potassium levels
1.5-2.5 mEq/L
normal serum Magnesium levels
135-145 mEq/L
normal serum Sodium levels
8.6-10.2
normal Calcium levels
7.35-7.45
normal pH levels
35-45 mm Hg
normal PaCO2
80-100 mm Hg
normal PaO2
95-100%
normal O2 saturation
Name that hormone!
targets the thyroid gland, causes secretion of thyroid hormones, originates in the anterior lobe of the pituitary gland
Thyroid Stimulating Hormone
Name that hormone!
targets Adrenal cortex (zona fasiculata), causes secretion of glucocorticoids (cortisol, corticosterone), originates in the anterior lobe of the pituitary gland
Adrenocorticotropic hormone
Name that hormone!
targets liver and adipose tissue, mobilizes lipid reserves, promotes glucose synthesis, and glycogen breakdown in the liver, elevates blood glucose concentrations, originates in the alpha cell of the pancreas
Glucagon
Name that hormone
targets most cells, increases energy utilization, oxygen consumption, growth and development and originates in the thyroid gland
Thyroxine (T4)
Triiodothyronine (T3)
Name that hormone
targets the kidneys, causes reabsorption of water, elevates blood volume and pressure, originates in the posterior lobe of the pituitary gland
Antidiuretic Hormone
Name that hormone
targets all cells, causes growth, protein synthesis, lipid mobilization and catabolism, originates in the the anterior lobe of the pituitary gland
Growth Hormone
Name that hormone
targets bone & kidneys, decreases Ca2+ concentrations in body fluids, originates in the C cells of the thyroid
Calcitonin
Name that hormone
targets the uterurs, mammary glands (female), ductus deferens and prostate gland (male), causes labor contractions, milk ejection, contractions of the ductus deferens and prostate gland, originates in the posterior lobe of the pituitary gland
Oxytocin
Name that hormone
targets bone and kidneys, increases Ca2+ concentrations in body fluids, originates in Parathroid (chief) cells
Parathyroid hormone
Name that gland
Production of ADH, oxytocin, and regulatory hormones
Hypothalamus
Name that gland
ACTH, TSH, GH, PRL, FSH, LH and MH
anterior lobe of the pituitary
Name that gland
Thyroxine, triiodothyronine, calcitonin
Thyroid gland
Name that gland
Epinephrine, norepinephrine
Adrenal medulla
Name that gland
cortisol, corticosterone, aldosterone, androgens
Adrenal cortex
Name that gland
insulin, glucagon
Pancreas
Name that gland
Melatonin
Pineal Gland
Name that gland
Parathyroid hormone
parathyroid glands
Common characteristics of hormones are
secretion in small amounts at variable but predictable rates; regulation by feedback systems; and binding to specific target cell receptors
Which is the most appropriate timing regarding the nurse’s administration of a rapid-acting insulin to a hospitalized patient?
a. give it 15 minutes before the patient begins a meal.
b. give it 1/2 hour before a meal
c. give it 1 hour before a meal
d. the timing of the insulin injection does not matter with insulin lispro
A. give it 15 minutes before the patient begins a meal
Which statement is appropriate for the nurse to include in patient teaching regarding type 2 diabetes?
a. Insulin injections are never used with type 2 diabetes.
b. You don’t need to measure your blood glucose levels because you are not taking insulin injections.
c. A person with type 2 diabetes still has functioning beta cells in his or her pancreas.
d. Patients with type 2 diabetes usually have better control over their diabetes than those with type 1 diabetes.
C. A person with type 2 diabetes still has functioning beta cells in his or her pancreas
The nurse monitoring a patient for a therapeutic response to oral antidiabetic drugs will look for
a. fewer episodes of diabetic ketoacidosis
b. weight loss of 5 pounds
c. hemoglobin A1C levels of less than 7%
d. glucose level of 150mg/dL
C. hemoglobin A1C levels of less than 7%
A patient with type 2 diabetes is scheduled for MRI with contrast dye. The nurse reviews the orders and notices that the patient is receiving metformin (Glucophage). Which action by the nurse is appropriate?
a. Proceed with the MRI as scheduled
b. Notify the radiology department that the patient is receiving Metformin.
c. Expect to hold the metformin the day of the test and for 48 hours after the test is performed
d. Call the prescriber regarding holding the metformin for 2 days before the MRI is performed
C. expect to hold the metformin the day of the test and for 48 hours after the test is performed
A patient with type 2 diabetes has a new prescription for repaglinide (Prandin). After 1 week, she calls the office to ask what to do, because she keeps missing meals. “I work through lunch sometimes, and I’m not sure whether I need to take it. What do I need to do?”
a. You need to try not to skip meals, but if that happens you will need to skip that dose of Prandin
b. We will probably need to change your prescription to insulin injections because you can’t eat meals on a regular basis.
c. Go ahead and take the pill when you first remember that you missed it
d. Take both pills with the next meal, and try to eat a little extra to make up for what you missed at lunchtime
A. You need to try not to skip meals, but if that happens you will need to skip that dose of Prandin.
When checking a patient’s fingerstick blood glucose level, the nurse obtains a reading of 42 mg/dL. The patient is awake but states he feels a bit cloudy headed. After double checking the patient’s glucose level and getting the same rewading, which action by the nurse is most appropriate?
a. Administer two packets of sugar
b. administer oral glucose in the form of a semisolid gel
c. administer 50% dextrose IV push
d. administer the morning dose of lispro insulin
B. administer oral glucose in the form of a semisolid gel
A patient is taking metformin for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects the nurse will include information about:
a. abdominal bloating
b. nausea
c. diarrhea
d. headache
e. weight gain
f. metallic taste
A B C F
3P’s of diabetes mellitus
polyuria, polydipsia, polyphagia
Rapid acting insulins
Humalog (lispro), Novolog (aspart), Apidra (glulisine)
Short acting insulins
Humulin R, Novolin R
Intermediate acting insulins
NPH (Isophane insulin suspension), Humulin N, Novolin N
Long acting insulins
Lantus (glargine), Levemir (detemir)
Combination Insulins
Humulin 70/30, Humulin 50/50, Novolin 70/30, Humalog Mix 7/25, Humalog 50/50, Novolog 70/30
Onset, Peak and Duration of Humalog(lispro)
O: 10-15 minutes, P: 60-90 minutes, D: 3-5 hours
Onset, Peak and Duration of Humulin R
SC O:0.5-1 hour, P: 2-4 hours, D: 5-7 hours
IV O:10-30min, P: 15-30min, D: 30-60 min
Onset Peak and Duration of Apidra (glulisine)
O: 15-20 minutes, P: 60-90 minutes, D:3-5 hours
Onset Peak and Duration of Novolin N
O: 2-4 hours, P: 4-12 hours, D: 12-18 hours
Onset Peak and Duration of Novolog (aspart)
O: 10-15 minutes, P: 60-90 minutes, D: 3-5 hours
Onset Peak and Duration of Novolin R
SC O:0.5-1 hour, P: 2-4 hours, D: 5-7 hours
IV O:10-30min, P: 15-30min, D: 30-60 min
Onset Peak and Duration of Humulin N
O: 2-4 hours, P: 4-12 hours, D: 12-18 hours
Onset Peak and Duration of Lantus (glargine)
O: 1-2 hours, P: no peak D: 24 hours
Onset Peak and Duration of Humulin 70/30, Humulin 50/50, and Novolin 70/30
O: 30-60 minutes, P:2-12 hours, D: 18-24 hours
Onset Peak and Duration of Levemir (detemir)
O: 1-2 hours, P: no peak D: 24 hours
Onset Peak and Duration of Humalog Mix 75/25, Humalog 50/50
O: 15 minutes, P: 1-6.5 hours, D: 18-24 hours
Onset Peak and Duration of Novolog Mix 70/30
O: 15 minutes, P: 1-4 hours, D: 18-24 hours
Name the disturbance
pH decreased, pCO2 increased, pO2 normal, HCO3 normal
uncompensated respiratory acidosis
Name the disturbance
pH decreased, pCO2 normal, pO2 decreased, HCO3 decreased
uncompensated metabolic acidosis
Name the disturbance
ph increased, pCO2 decreased, pO2 normal, HCO3 normal
uncompensated respiratory alkalosis
Name the disturbance
pH normal, pCO2 increased, pO2 increased, HCO3 increased
compensated respiratory acidosis
Name the disturbance
pH normal, pCO2 increased, pO2 increased, HCO3 increased
compensated metabolic alkalosis
name the disturbance
pH increased, pCO2 normal, pO2 increased, HCO3 increased
uncompensated metabolic alkalosis
name the disturbance
pH normal, pCO2 decreased, pO2 decreased, HCO3 decreased
compensated metabolic acidosis
name the disturbance
pH normal, pCO2 decreased, pO2 decreased, HCO3 decreased
compensated respiratory alkalosis
BUN range
10-20 mg/dL
Creatinine range
0.7-1.4 mg/dL
Which action by the nurse is most appropriate for the patient receiving an infusion of packed red blood cells?
a. flush the IV line with normal saline before the blood is added to the infusion
b. Flush the IV line with dextrose before the blood is added to the infusion
c. check the patient’s vital signs once the infusion is completed
d. anticipate that flushed skin and fever are expected reactions to a blood transfusion
A. flush the IV line with normal saline before the blood is added to the infusion
When preparing an IV solution that contains potassium, the nurse knows that a contraindication to the potassium infusion would be
a. diarrhea
b. serum sodium level of 145 mEq/L
c. serum potassium level of 5.6 mEq/L
d. dehydration
C. serum potassium level of 5.6 mEq/L
When assessing a patient who is about to receive an albumin infusion, the nurse knows that a contraindication for albumin would be
a. acute liver failure
b. heart failure
c. severe burns
d. fluid-volume deficit
B. heart failure
The nurse is preparing an infusion for a patient who has a deficiency in clotting factors. Which type of infusion is most appropriate?
a. Albumin 5%
b. packed RBCs
c. whole blood
d. fresh frozen plasma
D. fresh frozen plasma
While monitoring a patient who is receiving an infusion of a crystalloid solution, the nurse will monitor for which potential problem?
a. Bradycardia
b. hypotension
c. decreased skin turgor
d. fluid overload
D. fluid overload
The nurse is administering an IV solution that contains potassium chloride to a patient in the critical care unit who has a severely decreased serum potassium level. Which action(s) by the nurse are appropriate?
a. administer the potassium by slow IV bolus
b. administer the potassium at a rate no faster than 20 mEq/hr
c. monitor the patient’s cardia rhythm with a heart monitor
d. use an infusion pump for the administration of IV potassium chloride
e. administer the potassium IV push
B C D
The order reads “Infuse 1000mL of normal saline over the next 8 hours.” The IV tubing has a drop factor of 15gtt/mL. Calculate the mL/hour rate, and calculate the drops/minute setting for the IV tubing with this gravity infusion.
125mL/hr
31 gtt/min
Actions of Sulfonylurea
Glyburide (micronase, diabeta, glynase), Glipizide (glucotrol, glucotrol XL), Glimepiride (Amaryl)
Stimulates beta cells to release insulin via interaction with ATP-sensitive potassium channels in the beta cell membrane.
May increase sensitivity at receptor sites. May decrease secretion of glucagon.
Side effects of sulfonylurea
greatest risk for hypoglycemia.
Hypersensitivity reactions, GI distress, hepatotoxicity, and hematologic disorders,photosenstivitiy, rashes.
Causes mild weight gain
Nursing implications of Sulfonylureas
Oldest class
Hypoglycemia greater risk in elderly due to impaired renal or hepatic function
majority of sulfonylureas undergo renal elimination
Inform patient of possible cross-allergy to sulfonamide antibiotics
Actions of Meglitinides
Repaglinide (Prandin)
Nateglinide (Starlix)
Stimulates a rapid and short lived release of insulin from the pancreas- plasma level of insulin peaks within 30-60 minutes
Structurally different from sulfonylureas but also bind to ATP sensitivie potassium channels on beta cells
Side effects of Meglitinides (Glinides)
Greatest risk for hypoglycemia but due to short half life offers a reduced potential for hypoglycemia
Causes mild weight gain
Nursing implications of Meglitinides
Instruct patient to take anytime from 30 minutes before each meal right up to the time of the meal
If a meal is missed the drug should be omitted
Repaglinide may be useful alternative to a sulfonylurea in patients with renal impairment because it is cleared primarily by hepatic metabolism
Actions of Biguanide
Metformin (Glucophage, Glucophage XL)
Decreases the rate of hepatic glucose production
Increases peripheral glucose utilization
May be used alone or with sulonylureas, other oral agents, or insulin to treat type 2 diabetes
Side effects of Biguanide
b
